19

Dilemma Resolution
Guillem Feixas

One of my early influences in psychotherapy was existential. In the context

of the determinism that characterized both behaviorism and psychoanal-
ysis, the existential approach to therapy was fresh and illuminating. Human
beings could be seen from that point of view as beings who made choices
in the context of their circumstances. Those choices were not hazardous
but followed a sequence that was integrated in the person’s existential
project. As fascinating as this approach was for me, I realized it was too
philosophical to be adhered to for most psychologists in both clinical prac-
tice and research; and I found personal construct theory (PCT) just at that
point, with its strong emphasis on the person’s uniqueness and choice. As I
dug into the history of its creator, George A. Kelly, I realized that his
journey, the one that ended in his 1955 magnum opus, was not fueled by
philosophy but by true clinical experience. I found, and still find, it quite
unbelievable that a clinical psychologist developed an understanding of
human beings and their (our) functioning so deeply rooted in human
choice and so far away from essentialism and classification. PCT, already in
Kelly’s original work but going much further with the contributions of
those who felt inspired by his work, provides a general framework to develop
clinical practice and research which not only puts choice at the center of the
scene but also provides clinicians and researchers with a lot of choice. For
example, none of the procedures created by Kelly or his followers is
mandatory for a construct approach to psychological assessment and/or
intervention. Thus, clinicians can select among any of those procedures but
also among techniques originated in other traditions. They can even risk
asking the client what he or she thinks is the best way to approach his or
her problem.

The Wiley Handbook of Personal Construct Psychology, First Edition.

Edited by David A. Winter and Nick Reed.
© 2016 John Wiley & Sons, Ltd. Published 2016 by John Wiley & Sons, Ltd.
 Dilemma Resolution 231

However, one of the consequences of having the possibility of choice in

our lives is that it comes along with potential dilemmas. The possibility of
having a dilemma in a fully deterministic theoretical framework is greatly
reduced. But once you consider choice as a central aspect of human beings,
dilemmas are likely to appear in both their everyday situations and their
construct systems.

Construct Systems Are Not Logical

Our construct systems reflect the distinctions we made in our previous lived
and interpersonal experience (e.g., Procter, 2007)—not the experiences
themselves, but whatever we captured from them (Kelly, 1955/1991a,
1991b). Those distinctions, whether they can be verbalized or not, are our
personal constructs, which are organized in a hierarchical system. For
example in the personal construct system of Anna (one of our clients), being
“protective” (vs. “negligent”) implies being “demanding” (vs. “tolerant”).
The way Anna construed people in her family, and later in other contexts,
linked those two constructs in her system so that now when she construes
someone as “protective” she assumes that he or she will also be “demanding”
(and vice versa).
A construct system is composed of a network of personal constructs with
lines of implication among them, but PCT’s Organization Corollary asserts
that not all nodes of that net are at the same hierarchical level. Kelly’s
­distinction between peripheral and core constructs is one of the more
striking and farsighted contributions of PCT. Core constructs, at the top of
the hierarchy, define who we are—our identity—and also who we can
become, not in a void but in contrast or similarly to significant others. In
the example, “protective” was one of Anna’s core constructs (like her
brother but unlike other family members). We try to protect core con-
structs from invalidation because if that happened a large portion of our
system would consequently become invalidated so that we would have little
structure with which to make sense of events—and of ourselves! Although
she desired to be more “tolerant,” Anna did not want to become “negli-
gent”: that would be an attack on her sense of personal coherence. She
would resist that change as much as she could. It is preferable to suffer
invalidation at lower, more peripheral sections of the system rather than in
our core constructs. Even when peripheral invalidation involves suffering
and symptoms, PCT’s Choice Corollary suggests that our system will prefer
to protect our core constructs in order to retain the majority of its ­predictive
232 Guillem Feixas

capacity. From the combination of these two corollaries, Organization and

Choice, we can infer a basic human need for continuity and personal coher-
ence in spite of the fact that our construct system is continuously changing
with ongoing experience (Experience Corollary).
The functioning of construct systems outlined here can lead, however, to
some conflictual situations. Anna wants to change from being “demanding”
and would like to become more “tolerant” with others, and especially with
herself, but she finds it difficult to make that change in her life. Her need
for change in that aspect of her way of being conflicts with her need for
continuity in one of her core constructs (“protective”). That creates a
dilemma in her system because of the implications of the construct
“protective‐negligent” for the construct “demanding‐tolerant.” It is inter-
esting to note that people may or may not be aware of the conflicts existing
in their construct systems. Therefore, it is quite unusual that these dilemmas
appear in their description of the problem, except in situations such as drug
dependence or restricted eating in which that conflict is apparent in their
initial presentation of the problem.

The Dilemma of Therapy

As psychotherapists, we are seen by society and by our potential clients as

aligned with change. In our profession, many feel that it is completely natural
to push clients for change whether they express the need for change or not.
In the latter case, clients are usually seen as unmotivated and the focus of the
intervention is on convincing them of the necessity of change. When clients
express their wish for change, their “anti‐symptom position” (in coherence
therapy terms, see Ecker, Ticic, & Hulley, 2012), then all the resources of
most therapists are directed toward promoting change using counteracting
strategies (again in coherence therapy terms), those aimed at preventing or
eliminating symptoms. Psychoeducational and exposure techniques are
direct, clear examples of that. However, in many cases these counteractive
efforts do not attain their goal and clients either do not achieve change or,
if they do, change is easily reversed. In these situations, it is quite common
for therapists to feel invalidated in their role as change agents. Then, emo-
tions of frustration and anger are not infrequent. Labeling the client as
“resistant” is quite effective in getting some relief for therapists (protecting
their core constructs from invalidation) but it does not help clients much.
The need for continuity and coherence in our sense of identity has not
received enough consideration in psychology, and even less in the field of
 Dilemma Resolution 233

psychotherapy. This is not surprising given the fact that the professional
identity of psychotherapists usually includes the ability to promote benefi-
cial change for their clients. But here, if we take into account PCT, lies one
of the main dilemmas of psychotherapy. As psychotherapists we want to
help clients to achieve change, but clients have a strong and legitimate need
for continuity in their sense of identity. Concentrating all our energy as
therapists into pushing clients for change is often ineffective. Rather, PCT
suggests that therapists should show as much reverence to clients’ efforts to
protect their core constructs from invalidation as they do to their efforts to
change. Thus, reinforcing change when it occurs in our clients or high-
lighting their positive aspects might be, according to PCT, of some use
(validation is certainly convenient), but it might only take into account half
of the picture. Rather, our main goal, in cases in which these two forces are
in conflict, should be that of reconciling them. That is, in order to resolve
our dilemma as psychotherapists (we want to promote change but, at the
same time, respect the client’s identity), we propose harmonizing the need
for change with the need for continuity as the more appropriate stance for
psychotherapists working with clients whose construct systems are in
conflict, those with implicative dilemmas. Therefore, a therapy approach
inspired by PCT would not be focused on promoting change but on
­promoting a kind of change that is compatible with the person’s identity.
For that to be possible, some changes in core construing might also be
required in some cases: not because of the therapist’s pressure for change,
but because of a therapeutic stance that recognizes the courage needed for
such changes and the legitimacy of the client’s need for coherence.

Therapy for Dilemmas

Most therapies begin with the goal of eliminating some symptoms or

­distress and, thus, therapists try to understand the determinants of the
problem after proper assessment. Then, as mentioned, counteractive efforts
are directed to promoting problem resolution and therapists take a stance
in favor of change. But PCT suggests that we consider the symptoms and
problematic attitudes of clients as resulting from “choices” (usually not
conscious ones) in the context of their construct systems while, at the same
time, their choice for change, which is being expressed by requesting help
from a therapist, also stems from the same systems. Therefore, our proposal
is to focus therapy not on symptom resolution but on dilemma resolution.
That is, we have to join with each “part” of the client’s construct system,
234 Guillem Feixas

the one that goes for change and the one that pursues continuity, to help
the client recognize the existence and legitimacy of both, and focus therapy
work on making these two goals somehow compatible.
A therapy for dilemmas has some interesting implications if we look at
it in contrast to a counteractive therapy for problem or symptom resolu-
tion. When a client comes to see a therapist and presents a symptom it is
expected that the latter will propose some initiatives toward its resolution.
So the main responsibility of the therapy process lies in some implicit, and
sometimes explicit, way on the therapist’s side, on his or her resources or
techniques for change. In general, this is one of the most difficult aspects
of therapy because most therapists are aware that, ultimately, change can
only be carried out by clients. No matter how truthful or intelligent ther-
apists’ reasons for change are, nor how effective and reasonable their
techniques, the decisive point in therapy is how the therapists’ initiatives
are incorporated by clients into their lives. However, if therapy focuses on
the clients’ dilemmas instead, clients immediately realize that this is their
business. Clients might expect therapists to resolve their symptoms but
not their personal dilemmas. Once we change the focus of therapy from
symptoms to dilemmas, the expectations placed on therapists change, and
also their role. They are no longer seen as people who should have a
­solution to their clients’ problems but rather, hopefully, as companions to
their clients in their struggle to resolve their dilemmas.
For therapists, a focus on dilemmas entails a different stance. We are not
those who know the right solution to the clients’ problems but rather we
acknowledge that clients face a difficult challenge for which, to be honest,
in many cases we do not have an optimal solution. Milena was a 53‐year‐old
woman who had been diagnosed with major depressive disorder and was
seen with her husband. After a few conjoint sessions, it was apparent that
she was regretting having emigrated five years ago from South America, but
her husband was very happy with that decision. He was successful, and one
of their children had also come along with his wife and his newborn baby,
Milena’s grandchild. The dilemma in her life, leaving her husband and her
child and grandchild in Barcelona vs. going back to her beloved country to
join her two other children, reflected also many contradictory personal
meanings and values. Do we, as therapists, have a solution for that? In
dilemma therapy work, we do not assume that we have a solution to our
clients’ problems, and that is apparent also to the clients. Rather, we are
convinced that reconciling the two sides of the dilemma and finding a
course of action that respects both sides is the best way to go. How that
reconciliation manifests in practical, everyday terms is something we do not
 Dilemma Resolution 235

know, but is something that can emerge out of the collaboration between
the client as expert in his or her own life and the therapist as expert in the
therapy process (Feixas, 1995).

Identifying Dilemmas

We encounter clients’ dilemmas during the therapy process in many differ-

ent ways. Some clients express their reluctance to change right from the
beginning (as mentioned, this is very common in drug dependence), while
others express their wish for change but when taking steps in that direction
they become blocked. Others go back and forth, they make some progress
but then symptoms reappear, sometimes with unforeseen intensity (often
leading the therapist to despair). In addition to these clinical clues, PCT
also offers a method for studying personal construct systems, the repertory
grid technique (RGT), which permits identification of implicative dilemmas
(see, e.g., Feixas, Saúl, & Ávila‐Espada, 2009).
To identify an implicative dilemma in a grid, first we need to detect con-
gruent constructs (self now and ideal self are very close), those indicating
coherence. There is no need to change on these constructs (“protective”
vs. “negligent”, in the case of Anna). Second, we locate discrepant con-
structs (self now and ideal self are at opposite poles), those for which the
person expresses a wish to change (from being “demanding” to becoming
“tolerant” for Anna). Then we check for all the strong correlations bet-
ween these two types of constructs whenever the pole for which change is
desired correlates with the pole of the congruent construct on which change
is not desired.
Several studies conducted in the context of the Multicentre Dilemma
Project (www.usal.es/tcp) provided evidence that implicative dilemmas
were present in about half of a sample of psychotherapy clients (Feixas
et al., 2009), and this proportion was found to be higher in two different
samples of depressive patients (Feixas, Montesano, at al., 2014a, 2014b;
60% and 68% respectively), in one of bulimic patients (Feixas, Montebruno,
Dada, Del Castillo, & Compañ, 2010; 72%), and in one of patients with
fibromyalgia (Compañ et al., 2011; 77%). However, implicative dilemmas
were also found in control groups, although at rates that were definitively
lower (ranging from 19% to 47%). In all comparisons differences were
­statistically significant with a medium effect size.
Taken together these results suggest that though implicative dilemmas
are more prevalent in some clinical samples, they are not negligible in
236 Guillem Feixas

­ on‐clinical ones, suggesting that their presence might be a transdiagnostic

n
condition of some construct systems which might be associated with
psychological distress. In any case, our main point is that in trying to help
a client who requests help, if an implicative dilemma is found, then focusing
on that dilemma should substantially facilitate the therapy process.

Changing Dilemmas

Therapy for dilemmas can be manualized, and we have done so for a

­controlled efficacy study for depression (Feixas, Bados, et al., 2013), but
here I want to picture the general approach of such a therapy. In fact, the
more central considerations have already been outlined above, and those
regard the therapist’s attitudes. The more difficult part in the practical
training of dilemma therapists is restraining them from pushing clients
for  change (giving “good” advice, prescribing “well‐intended” activities,
giving “solutions” to problems, etc.).
In addition to facilitative attitudes, therapists seem to need techniques
and procedures. PCT has been quite powerful in inspiring those as well,
and many of them can be adapted for working with dilemmas: laddering
procedures for exploring the implications of the constructs involved in the
dilemma; controlled elaboration of situations involving dilemmas; genera-
tion of alternatives to the dilemma; and fixed‐role enactment of the solved
dilemma, to mention a few (see Feixas & Saúl, 2005).
The ABC technique does not need any adaptation for dilemma work
because it was originally devised for that goal. This procedure has proven
extremely useful in working with many clients. However, since it has been
described in a very elegant way elsewhere (Tschudi & Winter, 2012), here
I will present the magic wand technique, which has proven to be quite a
useful instrument in working experientially along those lines.
The magic wand was introduced to Anna by asking her to imagine the
therapist was holding a wand (the therapist waved a pen or pencil in a
gesture suggesting a magic trick) that had the magical power to convert her
into a “tolerant” person: “Imagine leaving the session today being a tol-
erant person. Close your eyes and feel the sensations of that change. How
would your life be? How would you behave from now on? How would you
feel when being with your partner? When talking to your mother? And
when talking to your father?” After several seconds she began to utter that
it was wonderful to achieve that change so easily, but in going deeper into
that “new self” she did not look so happy even when describing the ­practical
 Dilemma Resolution 237

advantages of being tolerant. The therapist noticed that, and asked her
whether all the sensations she was experiencing were positive or whether
there were also sensations of other kinds. She responded:

Anna: “Well, it is very strange. I think it’s better now but I don’t really feel
better. It’s very strange.”
Therapist: “Why don’t you have a closer look at those not‐so‐positive
sensations?”
Anna: “On the one hand, there is this strange sensation of not being me. But
when imagining being with others, my partner for example, then some
worries emerge. I wonder whether by being so tolerant I am missing some
of his experiences; besides, he might feel I don’t care much about what he
does and feels, somehow leaving him to his own fate.”

The therapist then asked Anna to contrast that sensation with her present
sensation as a “demanding” spouse. She then spoke more fluidly, saying
that she might be a bit of a nuisance for him but at least she was sure he had
her in his mind most of the time and that reassured her that he noticed she
was really close to him. The therapist commented on the importance being
close had for her and asked Anna to reflect on that:

Anna: “It is not only that I need to feel close to him because of my emotional
needs but also that I feel I can protect him more from the many hazards
that we encounter in the course of life. This way I am more aware of his
needs.”
Therapist: “It looks like even when becoming more tolerant seems to be
advantageous in many ways, abandoning your demanding attitude has also
some disadvantages.”
Anna: “Yes . . . Actually, this change would involve more issues than I had
expected.”
Therapist: “It looks like, so far, you felt closer to your partner by being
demanding than by becoming tolerant.”
Anna: “Oh yes! But couldn’t I be more tolerant while keeping my closeness
to him?”

This is a wonderful moment in the therapy process. Anna clearly takes

the lead in the process by suggesting a possible solution to the dilemma.
By looking at the diagram of Anna’s dilemma (Figure 19.1), a professional
with some training in PCT and knowledgeable of implicative dilemmas
could easily see the solution to the dilemma: loosening the lines of impli-
cation of the congruent construct on the discrepant one so that being
238 Guillem Feixas

Undesired
pole
Demanding Tolerant

Congruent
construct Protective Negligent

Correlated Correlated

Does not love

Discrepant Loves herself
herself
construct

Present self Ideal self

Desired
pole

Figure 19.1  A Diagrammatic Representation of Anna’s Implicative Dilemma.

tolerant would not imply being negligent, making being protective com-
patible with being tolerant. However, if the therapist had explained this
“clever” solution to the client right at the beginning, the chances are that
this intervention would have had a limited effect. As emphasized by propo-
nents of coherence therapy (Ecker et al., 2012), it is essential for therapy
work to involve clients in the experiential discovery of their internal con-
flicts. It would not have been a good idea for the therapist at this moment
to snatch the leading role in therapy from the client and signal to her the
way to proceed by prescribing actions, ways of thinking, or attitudes.
Instead, once the client takes a step forward in creating a new course of
action, it is of paramount importance for the therapist to stay in a role that
permits the client to move forward in that direction.

Therapist: “Oh! . . . That is an interesting idea that you had: to find a way to
be less demanding but still close to others, is that what you mean?”
Anna: “I guess so.”
Therapist: “And how do you imagine that could be possible? How would you
do it during this next week?”

We can see here, at this point, the general outline of this dilemma work.
The therapist becomes an assistant to the client in her efforts at constructing
 Dilemma Resolution 239

a way to approach herself and others characterized by being more tolerant

but, at the same time, remaining protective. Maybe that shift will need some
redefinition of these two constructs, or of even more constructs. Anna will
carry out “tolerant” actions and attitudes but paying close attention to any
potential negligence they could involve. As in fixed‐role therapy, we will
check the reactions of significant others to Anna’s change of perspective.
Further sessions will have to include explorations of the dilemma in the
­context of other significant relationships (mother, father, co‐workers, etc.).
Does the issue of closeness appear in connection to becoming more t­ olerant?
If so, does it have the same significance in the context of each relationship?
The general idea I have tried to portray here about working with implicative
dilemmas is that even when RGT identifies one or more dilemmas for a client,
we should not just reveal the dilemma to the client in a didactic manner, but
rather promote experiences in therapy leading up to the emergence of the chal-
lenges to identity and personal coherence that the desired change would entail.
Once those challenges emerge, we should do our best to leave the client in the
position of making the choices involved in p­ ursuing a course of action which is
the most appropriate from this new perspective. My concern as a therapist is
not with the content and direction of those decisions (as long as they lie within
ethical limits) but rather with whether they are made in the course of a lived
process in which the construct system becomes more integrated, with more
dilemmas solved, and, thus, with a higher degree of existential freedom.

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